安徽5县农村女性HPV感染及宫颈病变分析

Prevolence of human papillomavirus infection and cervical lesions among rural women in five counties of Anhui province

目的了解5个县农村女性人乳头瘤病毒（HPV）感染与宫颈病变分布特征,探讨宫颈癌防治对策。方法 2014年在安徽省5个县抽取21 078名35~64岁农村妇女,进行高危亚型/高危分型HPV初筛,并根据HPV初筛结果进行宫颈细胞学、阴道镜、病理等进一步检查,分析HPV感染状况和型别以及病理检查结果。结果21 078名妇女HPV初筛阳性检出率为8.01%,其中检出率最高的16型占18.41%;5个县中HPV初筛阳性检出率为6.06%~9.43%,且各县6种常见型别HPV检出率排序不同,差异均有统计学意义;35~39岁HPV初筛阳性检出率最低,为6.90%,55~65岁最高,为8.94%,随着年龄增加检出率呈现上升趋势（P〈0.05）;HPV检测对于识别宫颈病变具有较高的灵敏度和阳性预测值,分别为98.44%和89.74%;HPV检测对于识别宫颈癌及癌前病变灵敏度和阴性预测值均为100.00%;宫颈癌和癌前病变检出率为488.66/10万,HPV初筛结果阳性者中宫颈癌和癌前病变检出率为9.18%。结论安徽省5县HPV检出率存在地区差异,HPV检出率随年龄增长而增加,HPV初筛有助于宫颈早期病变的早发现和早干预。

Objective To examine prevalent characteristics of human papillomavirus（ HPV） infection and cervical lesions among rural women in 5 counties of Anhui province for making cervical cancer prevention and treatment strategies. Methods Totally 21 078 rural women aged 35- 64 years were recruited in 5 counties of Anhui province with stratified cluster sampling in 2014. First,primary screening for high risk and high risk subtype HPV infection were screened among the women selected. Then cervical cytology test,vaginal examination,pathology detection,and other examination were further conducted among the participants with positive or suspected results of the primary screening. HPV infection status and reults of clinical and pathological examination were analyzed with SPSS 16. 0. Results The detection rate of HPV infection was 8. 01% in the women and the most prevalent infection type was HPV16（ 18. 41%） among the HPV positive women. Significant regional difference in both the detection rate（ from 6. 06% to 9. 43%） and the infection ratio of the 6 common HPV strains were observed among the 5 counties. The HPV detection rate increased with the increment of age among the women（ P〈0. 05）,with the lowest（ 6. 90%） and the highest（ 8. 94%） among the women at the ages of35- 39 and 55- 65 years. The sensitivity and positive predictive value of HPV detection for the identification of cervical lesions were 98. 44% and 89. 74%,respectively. The sensitivity and negative predictive value of HPV detection for both the identification of cervical cancer and precancerous lesions were 100%. The incidences of cervical cancer and precancerous lesions were 488. 66 /100 000 among all the women surveyed and the positive rate of cervical cancer and precancerous lesions was 9. 18% in the women positive to HPV. Conclusion There is a significant regional difference in the detection rate of HPV infection and the detection rate increases with the increment of age among the women from the 5counties of Anhui province. HPV detection is helpful for early prevention and intervention of early cervical lesions.